Basic Information
| Provider Information | |||||||||
| NPI: | 1952529810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOCHIN | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | FNP - CERTIFIED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544 W. UMPQUA ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416729596 | ||||||||
| FaxNumber: | 5414643519 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 S. MAIN | ||||||||
| Address2: | |||||||||
| City: | MYRTLE CREEK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418604070 | ||||||||
| FaxNumber: | 5418605032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP87-006827-7 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 168395 | 05 | OR | MEDICAID | R103163 | 01 | OR | MEDICARE PART B | OTHER |